Average Medicaid Office Visit Payments
Typical Medicaid Office Visit reimbursement across 14,934 cities
Avg. Medicaid Paid
$51.55
Price Range
$0.00 – $907.39
Total Claims
1469.2M
Cities
14934
Typical Payment Range
Typical Medicaid Office Visit payments fall between $29.28 and $67.92 per claim (median: $46.55). The top 10% of payments exceed $95.29.
Based on per-provider averages across all Medicaid claims in this category.
About This Procedure
A standard doctor's office visit for evaluation and management of medical conditions. Includes new patient visits, follow-up visits, and consultations.
Why do these costs look low?
These figures represent Medicaid reimbursement rates — the amounts that state Medicaid programs actually paid providers. Medicaid typically reimburses significantly less than private insurance or out-of-pocket prices. If you have private insurance or are paying cash, expect higher costs. See the cost components below for per-code averages.
Costs by City
| City | Avg. Paid | Min / Max | Claims | Providers |
|---|---|---|---|---|
| Jamaica, NY | $73.57 | $0.00 – $285.69 | 2,187,688 | 514 |
| Salinas, CA | $33.22 | $0.00 – $932.94 | 2,189,013 | 394 |
| Merced, CA | $28.40 | $0.00 – $1,181 | 2,195,639 | 268 |
| Flint, MI | $59.35 | $0.22 – $418.16 | 2,201,986 | 253 |
| Charleston, SC | $64.67 | $0.00 – $482.26 | 2,228,092 | 1159 |
| Newark, NJ | $61.77 | $0.00 – $389.10 | 2,237,116 | 681 |
| Jackson, MS | $49.60 | $0.00 – $463.60 | 2,247,839 | 1123 |
| Columbia, SC | $72.57 | $0.00 – $365.16 | 2,249,167 | 1174 |
| Tulsa, OK | $98.94 | $0.00 – $653.97 | 2,263,615 | 1590 |
| Elmhurst, NY | $64.45 | $0.00 – $244.72 | 2,285,070 | 407 |
| Modesto, CA | $28.79 | $0.00 – $773.32 | 2,335,494 | 632 |
| Fort Worth, TX | $52.71 | $0.00 – $719.00 | 2,341,902 | 1304 |
| Spokane, WA | $54.17 | $0.00 – $470.83 | 2,408,136 | 1419 |
| Santa Ana, CA | $36.81 | $0.00 – $1,003 | 2,438,108 | 518 |
| Buffalo, NY | $60.22 | $0.00 – $254.62 | 2,438,221 | 1026 |
| Greenville, SC | $63.19 | $0.00 – $719.00 | 2,475,692 | 1448 |
| Aurora, CO | $70.37 | $0.00 – $601.91 | 2,536,346 | 2428 |
| Saint Louis, MO | $61.54 | $0.00 – $446.63 | 2,573,779 | 2734 |
| San Bernardino, CA | $36.81 | $0.00 – $3,143 | 2,587,883 | 410 |
| Richmond, VA | $68.82 | $0.00 – $241.64 | 2,636,996 | 1705 |
| Springfield, MA | $71.94 | $0.00 – $446.14 | 2,654,243 | 1017 |
| Fort Wayne, IN | $58.43 | $0.00 – $556.51 | 2,675,831 | 1408 |
| Toledo, OH | $54.00 | $0.00 – $671.64 | 2,678,328 | 1257 |
| Tampa, FL | $52.28 | $0.00 – $577.09 | 2,709,920 | 1616 |
| El Paso, TX | $46.37 | $0.00 – $689.70 | 2,780,417 | 1029 |
| Anaheim, CA | $31.75 | $0.00 – $937.18 | 2,783,225 | 669 |
| Mesa, AZ | $53.86 | $0.00 – $206.67 | 2,804,171 | 1150 |
| Long Beach, CA | $25.33 | $0.00 – $1,072 | 2,819,486 | 915 |
| Stockton, CA | $24.17 | $0.00 – $1,059 | 2,830,080 | 517 |
| Oklahoma City, OK | $102.71 | $0.00 – $719.00 | 2,863,066 | 2038 |
| Visalia, CA | $11.38 | $0.00 – $855.23 | 2,887,946 | 368 |
| Lafayette, LA | $39.01 | $0.00 – $333.15 | 2,898,304 | 775 |
| Colorado Springs, CO | $95.93 | $0.00 – $1,477 | 2,902,599 | 1625 |
| Akron, OH | $82.36 | $0.00 – $318.75 | 2,903,849 | 1279 |
| Oakland, CA | $19.22 | $0.00 – $949.89 | 2,992,452 | 1231 |
| Dayton, OH | $64.03 | $0.00 – $384.54 | 3,013,507 | 1213 |
| Orlando, FL | $66.63 | $0.00 – $1,030 | 3,037,031 | 1866 |
| San Juan, PR | $18.99 | $0.00 – $590.91 | 3,140,039 | 1050 |
| Seattle, WA | $64.74 | $0.00 – $784.86 | 3,147,175 | 3468 |
| Dearborn, MI | $66.33 | $0.00 – $129.78 | 3,194,505 | 244 |
| Portland, OR | $73.00 | $0.00 – $1,356 | 3,294,065 | 3477 |
| Grand Rapids, MI | $56.03 | $0.00 – $695.81 | 3,306,257 | 314 |
| Rochester, NY | $80.81 | $0.00 – $532.82 | 3,372,720 | 2362 |
| Shreveport, LA | $44.74 | $0.00 – $263.31 | 3,418,347 | 1092 |
| Knoxville, TN | $45.18 | $0.00 – $232.03 | 3,462,740 | 1776 |
| Riverside, CA | $33.28 | $0.00 – $2,827 | 3,628,375 | 1030 |
| Denver, CO | $89.80 | $0.00 – $671.04 | 3,664,561 | 2164 |
| Dallas, TX | $47.45 | $0.00 – $937.10 | 3,693,999 | 1988 |
| Memphis, TN | $39.77 | $0.00 – $353.72 | 3,737,410 | 1657 |
| Charlotte, NC | $61.85 | $0.00 – $827.92 | 3,946,873 | 2854 |
Cost Components
National averages for each billing code in this procedure category. Sorted by claim volume.
| Code | Description | Avg. Paid | Claims | Providers |
|---|---|---|---|---|
| 99213 | Office visit established mod | $43.18 | 764,306,590 | 487,602 |
| 99214 | Office visit established mod-hi | $59.53 | 502,480,931 | 466,856 |
| 99212 | Office visit established low | $41.69 | 92,299,154 | 127,462 |
| 99203 | Office visit new moderate | $67.55 | 47,756,882 | 127,334 |
| 99211 | Office visit established minor | $39.24 | 44,127,221 | 47,748 |
| 99204 | Office visit new moderate-high | $92.03 | 32,379,031 | 111,937 |
| 99215 | Office visit established high | $93.58 | 29,619,773 | 74,725 |
| 99202 | Office visit new low | $58.57 | 9,372,712 | 35,486 |
| 99205 | Office visit new high | $136.10 | 3,665,382 | 19,737 |
| 99244 | Office consultation mod-high | $118.25 | 3,405,681 | 11,884 |
| 99243 | Office consultation moderate | $78.55 | 2,585,480 | 8,432 |
| 99245 | Office consultation high | $132.29 | 645,300 | 3,046 |
| 99242 | Office consultation low | $58.27 | 483,445 | 1,980 |
| 99241 | Office consultation brief | $66.15 | 295,664 | 712 |
These averages group common billing codes used when providers bill Medicaid for this procedure. Individual costs will vary.